Intensive Care Delirium Screening Checklist: evaluation of a new screening tool
Abstract
Objective Delirium in the intensive care unit is poorly defined. Clinical evaluation is difficult in the setting of unstable, often intubated patients. A screening tool may improve the detection of delirium.Method We created a screening checklist of eight items based on DSM criteria and features of delirium: altered level of consciousness, inattention, disorientation, hallucination or delusion, psychomotor agitation or retardation, inappropriate mood or speech, sleep/wake cycle disturbance, and symptom fluctuation. During 3 months, all patients admitted to a busy medical/surgical intensive care unit were evaluated, and the scale score was compared to a psychiatric evaluation.Results In 93 patients studied, 15 developed delirium. Fourteen (93%) of them had a score of 4 points or more. This score was also present in 15 (19%) of patients without delirium, 14 of whom had a known psychiatric illness, dementia, a structural neurological abnormality or encephalopathy. A ROC analysis was used to determine the sensitivity and specificity of the screening tool. The area under the ROC curve is 0.9017. Predicted sensitivity is 99% and specificity is 64%.Conclusion This study suggests that the Intensive Care Delirium Screening Checklist can easily be applied by a clinician or a nurse in a busy critical care setting to screen all patients even when communication is compromised. The tool can be utilized quickly and helps to identify delirious patients. Earlier diagnosis may lead to earlier intervention and better patient care.
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Delirium was assessed twice daily by nurses or physicians until ICU discharge using the Intensive Care Delirium Screening Checklist (ICDSC).
“Similarly, delirium was assessed for each patient twice daily by nurses or physicians until ICU discharge by using the Intensive Care Delirium Screening Checklist (ICDSC) score [22] (Additional data file 3).”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [22]
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“Delirium is a syndrome characterized by the acute onset of cerebral dysfunction with a change or fluctuation in baseline mental status, inattention, and either disorganized thinking or an altered level of consciousness (307-313).”
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“Moreover, the ICDSC study included patients with neurological or psychiatric diagnoses, or abnormal consciousness on admission, and thus incorporated many patients who were excluded in substantiating the CAM-ICU [22].”
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“Bergeron N, Dubois MJ, Dumont M, et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool.”
MethodThe checklist—a tool for error management and performance improvement
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“Of the patients included in this study, 93% of patients having developed delirium obtained a significantly high score on the screening checklist, whereas only 19% of patients having not developed delirium had similar scores (sensitivity, 99%; specificity, 64%) [27].”
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“For delirium, the Confusion Assessment Method for the Intensive Care Unit (39) or the Intensive Care Unit Delirium Screening Checklist (40) can be proposed.”
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“Each patient admitted to the SICU and included in the study was evaluated prospectively by research staff physicians and one of the bedside nurses to establish a diagnosis of delirium, using the ICDSC [18].”
MethodInfluentialSepsis Associated Encephalopathy
Chaudhry, N., & Duggal, A. K. (2014) · Advances in Medicine · doi:10.1155/2014/762320 · Cited by 241 · see citing works
“In nonsedated patients mental status is straightforwardly assessed by the Confusion Assessment Method (CAM) for patients outside the ICU and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for patients admitted to the ICU.”
Delirium assessment in the critically ill
Devlin, J. W., Fong, J. J., Fraser, G. L., & Riker, R. R. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0603-5 · Cited by 222 · see citing works
“A major reason for the higher specificity that is reported with CAM-ICU (89%) than ICDSC (64%) is that patients with neurological injury and structural neurological abnormalities were excluded from the CAM-ICU but not the ICDSC validation studies [2, 32, 33].”
BackgroundMethodInfluentialThe impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients
Lat, I., McMillian, W., Taylor, S., Janzen, J. M., Papadopoulos, S., Korth, L., Ehtisham, A., Nold, J., Agarwal, S., Azocar, R., et al. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e31819ffe38 · Cited by 222 · see citing works
“Several validated tools exist to assist in the diagnosis of delirium in the critically ill population (2, 3).”
MethodClinical review: The ABC of weaning failure - a structured approach
Heunks, L. M. A., & van der Hoeven, J. G. (2010) · Critical Care · doi:10.1186/cc9296 · Cited by 220 · see citing works
Preventing Delirium in the Intensive Care Unit
Brummel, N. E., & Girard, T. D. (2012) · Critical Care Clinics · doi:10.1016/j.ccc.2012.10.007 · Cited by 214 · see citing works
Critical Care Nurses’ Role in Implementing the “ABCDE Bundle” Into Practice
Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L. M., Pun, B. T., Olsen, K. M., Peitz, G. J., & Ely, E. W. (2012) · Critical Care Nurse · doi:10.4037/ccn2012229 · Cited by 214 · see citing works
Sepsis-Associated Encephalopathy: From Delirium to Dementia?
Chung, H., Wickel, J., Brunkhorst, F. M., & Geis, C. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9030703 · Cited by 219 · see citing works
“In the intensive care unit, the CAM‐ICU [81] or the intensive care delirium checklist (ICDSC) [82] are most commonly used.”
MethodInfluentialValidity and Reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients
Guenther, U., Popp, J., Koecher, L., Muders, T., Wrigge, H., Ely, E. W., & Putensen, C. (2009) · Journal of Critical Care · doi:10.1016/j.jcrc.2009.08.005 · Cited by 213 · see citing works
Assessment of Delirium in the Intensive Care Unit: Nursing Practices And Perceptions
Devlin, J. W., Fong, J. J., Howard, E., Skrobik, Y. K., McCoy, N., Yasuda, C., & Marshall, J. (2008) · American Journal of Critical Care · doi:10.4037/ajcc2008.17.6.555 · Cited by 211 · see citing works
Self-citationThe intensive care delirium research agenda: a multinational, interprofessional perspective
Pandharipande, P. P., Ely, E. W., Arora, R. C., Balas, M. C., Boustani, M. A., Calle, G. H. L., Cunningham, C. M., Devlin, J. W., Elefante, J., Han, J. H., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4860-7 · Cited by 211 · see citing works
Self-citationICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit
Kotfis, K., Marra, A., & Ely, E. W. (2018) · Anaesthesiology Intensive Therapy · doi:10.5603/ait.a2018.0011 · Cited by 206 · see citing works
“The scales most widely used in delirium monitoring and recommended by CCM [6] include the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [27] and the Intensive Care Delirium Screening Checklist (ICDSC) [28].”
MethodInfluentialApolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients*
Ely, W., Girard, T. D., Shintani, A., Jackson, J. C., Gordon, S. M., Thomason, J. W. W., Pun, B. T., Canonico, A. E., Light, R. W., Pandharipande, P. P., et al. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000251925.18961.ca · Cited by 200 · see citing works
Sedation and Analgesia in the Mechanically Ventilated Patient
Patel, S. B., & Kress, J. P. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201102-0273ci · Cited by 205 · see citing works
Morandi, A., Pandharipande, P. P., Trabucchi, M., Rozzini, R., Mistraletti, G., Trompeo, A. C., Gregoretti, C., Gattinoni, L., Ranieri, M. V., Brochard, L. J., et al. (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1177-6 · Cited by 201 · see citing works
“, acute change or fluctuation in mental status and inattention, accompanied by either disorganized thinking or an altered level of consciousness) [1] occurs in 20–40% of non-critically ill, hospitalized patients with rates as high as 80% in critically ill surgical and medical ICU patients [2–10], depending on the seve…”
BackgroundSelf-citationAn Updated Focused Review of Dexmedetomidine in Adults
Gerlach, A. T., Murphy, C. V., & Dasta, J. F. (2009) · Annals of Pharmacotherapy · doi:10.1345/aph.1m310 · Cited by 200 · see citing works
Kong, H., Xu, L., & Wang, D. (2022) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.13873 · Cited by 206 · see citing works
Meta-Analysis of Factors Which Influence Delirium Following Cardiac Surgery
Lin, Y., Chen, J., & Wang, Z. (2012) · Journal of Cardiac Surgery · doi:10.1111/j.1540-8191.2012.01472.x · Cited by 192 · see citing works
Children's Factual and Delusional Memories of Intensive Care
Colville, G. A., Kerry, S., & Pierce, C. M. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200706-857oc · Cited by 193 · see citing works
“Opiates 94 (92) Thiopentone 4 (4) Propofol 2 (2) Paralyzing drugs 42 ( 43 )”
MethodPatient-Focused Sedation and Analgesia in the ICU
Sessler, C. N., & Gill, K. V. (2008) · CHEST Journal · doi:10.1378/chest.07-2026 · Cited by 189 · see citing works
Pandharipande, P. P., Banerjee, A., McGrane, S., & Ely, E. W. (2010) · Critical Care · doi:10.1186/cc8999 · Cited by 188 · see citing works
“Development of easy to use delirium monitoring instruments such as the Confusion Assessment Method for the ICU [11] and the Intensive Care Delirium Screening Checklist [ 12 ] (the D of the ABCDEs) led to investigations that quantifi ed the undesirable consequences of delirium in the critically ill [5-7], and identifi…”
MethodSchubert, M., Schürch, R., Böettger, S., Núñez, D. G., Schwarz, U., Béttex, D., Jenewein, J., Bogdanović, J., Stähli, M. L., Spirig, R., et al. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3345-x · Cited by 188 · see citing works
Prevalence and Risk Factors for Development of Delirium in Burn Intensive Care Unit Patients
Agarwal, V., O’Neill, P. J., Cotton, B. A., Pun, B. T., Haney, S., Thompson, J. L., Kassebaum, N. J., Shintani, A., Guy, J., Ely, E. W., et al. (2010) · Journal of Burn Care & Research · doi:10.1097/bcr.0b013e3181eebee9 · Cited by 185 · see citing works
Hagel, S., Bach, F., Brenner, T., Bracht, H., Brinkmann, A., Annecke, T., Höhn, A., Weigand, M. A., Michels, G., Kluge, S., et al. (2022) · Intensive Care Medicine · doi:10.1007/s00134-021-06609-6 · Cited by 188 · see citing works
Assessment scales for delirium: A review
Grover, S. (2012) · World Journal of Psychiatry · doi:10.5498/wjp.v2.i4.58 · Cited by 183 · see citing works
Martin, J., Heymann, A., Bäsell, K., Baron, R., Biniek, R., Bürkle, H., Dall, P., Dictus, C., Eggers, V., Eichler, I., et al. (2010) · PubMed Central · doi:10.3205/000091 · Cited by 184 · see citing works
“RASS: Richmond Agitation Sedation Scale (-5 to +4) VAS: Visual Analogue Scala, VRS: Verbale Rating Scala, NRS: Numeric Rating Scale (0-10) BPS: Behavioral Pain Scale (3-12), PAINAD: Pain Assessment in Advanced Dementia (0-10) CAM-ICU: Confusion Assessment Method for the ICU (positive/negative) ICDSC: Intensive Care De…”
BackgroundMethodInfluentialHayhurst, C. J., Pandharipande, P. P., & Hughes, C. G. (2016) · Anesthesiology · doi:10.1097/aln.0000000000001378 · Cited by 184 · see citing works
- Authors
- Bergeron, N., Dubois, M.-J., Dumont, M., Dial, S., & Skrobik, Y.
- Affiliations
- Hôpital Maisonneuve-Rosemont (CA)
- McGill University (CA)
- Corresponding author
- Skrobik, Y.
- Venue
- Intensive Care Medicine
- Published
- 2001-04-20
- Volume
- 27
- Issue
- 5
- Pages
- 859-864
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2143617649
- Cited by
- 1,487
- References
- 0
- Citations by year
- 2026: 78 · 2025: 85 · 2024: 96 · 2023: 94 · 2022: 80 · 2021: 96 · 2020: 110 · 2019: 78 · 2018: 70 · 2017: 79 · 2016: 66 · 2015: 64 · 2014: 60 · 2013: 74 · 2012: 73
- FWCI
- 6.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- delirium, intensive care unit, delirium screening, screening checklist, intensive care, altered level of consciousness, psychomotor agitation, sleep-wake disturbances, sensitivity and specificity, early diagnosis
- MeSH terms
- Adult, Aged, Aged, 80 and over, Critical Care, Delirium, Female, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, ROC Curve, Sensitivity and Specificity, Critical Illness, APACHE
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